Rental Form

To request a wheelchair van rental online, complete the following form, print a copy for your records, and click the send button.

If you prefer not to register online call us at 877-865-5570.

First Name:*
Last Name:*
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:*
Insurance Company:
Insurance Policy Number:
Pick Up Date:*
Return Date:*

Accessible Vans And Mobility Wheelchair Vans for Rent

AV&M offers a wheelchair accessible van rental service to Southern New Jersey, Eastern Pennsylvania, and Northern Delaware. Our handicap van rental rates are very competitive, and we will work hard to earn your business.

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